title: Combined chemotherapy and intra-arterial chemotherapy of retinoblastoma.
abstract: OBJECTIVE
  Retinoblastoma (RB) is the most common primary malignant intraocular tumor in children. Although systemic chemotherapy has been the primary treatment, intra-arterial chemotherapy (IAC) represents a new treatment option. Here, we performed alternate systemic chemotherapy and IAC and retrospectively reviewed the efficacy and safety of this approach.
  
  
  METHODS
  Patients diagnosed with intraocular RB between January 2000 and December 2011 at Severance Children's Hospital, Yonsei University, were reviewed. Before February 2010, the primary treatment for RB was chemotherapy (non-IAC/CTX). Since February 2010, the primary treatment for RB has been IAC (IAC/CTX). External beam radiotherapy or high-dose chemotherapy were used as "last resort" treatments just prior to enucleation at the time of progression or recurrence during primary treatment. Enucleation-free survival (EFS) and progression-free survival were assessed.
  
  
  RESULTS
  We examined 19 patients (median age, 11.9 months; range, 1.4 to 75.6 months) with a sum of 25 eyes, of which, 60.0% were at advanced Reese Ellsworth (RE) stages. The enucleation rate was 33.3% at early RE stages and 81.8% at advanced RE stages (P=0.028). At 36 months, EFS was significantly higher in the IAC/CTX group than in the non-IAC/CTX group (100% vs. 40.0%, P=0.016). All 5 patients treated with IAC achieved eye preservation, although most patients were at advanced RE stages (IV-V).
  
  
  CONCLUSIONS
  Despite the limitation of a small sample size, our work shows that an alternative combined approach using IAC and CTX may be safe and effective for eye preservation in advanced RB.
authors.affiliation: Division of Pediatric Hematology and Oncology, Department of Pediatrics, Yonsei University Health System, Seoul, Korea.
authors.forename: Saerom
authors.initials: S
authors.lastname: Choi
authors.forename: Jung Woo
authors.initials: JW
authors.lastname: Han
authors.forename: Hyosun
authors.initials: H
authors.lastname: Kim
authors.forename: Beom Sik
authors.initials: BS
authors.lastname: Kim
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Sung Chul
authors.initials: SC
authors.lastname: Lee
authors.forename: Chuhl Joo
authors.initials: CJ
authors.lastname: Lyu
keywords: Combination chemotherapy; Eye enucleation; Intra-arterial infusion; Retinoblastoma